30 September 2023

Wealthy visitors "toured" Bedlam asylum

Note the well dressed tourists in Bedlam
The Rake’s Progress: Scene 8, 
by William Hogarth, 1735 
Sir John Soane’s Museum. 

Originally Bethlehem was founded in 1247 as the Priory of St Mary in Bishopsgate St, just outside the City of London walls. In the next century it was mentioned as a hos­pital in a 1330 license grant­ed to collect alms. Bethlehem (house of bread in Hebrew) was a hospital intended for the poor who were suffering from a] an ail­ment and b] homelessness. Then a report of a Royal Commiss­ion in 1405 confirmed that Bethlehem was to be used partly as an insane asylum.

Bethlehem was popularly shortened to Bedlam. In 1375 Bedlam became a royal hospital and later it reverted to the city. Early in the C16th the word Bedlam was used by Tyndale to mean a madman, so the hos­p­ital was ex­cl­usively used as a lunatic asylum. Over generations, the attitude of Englishmen towards the insane could be easily traced at Bedlam.

In 1674, when the old premises had become unusable, it was decided to build another hospital. It moved a short distance to Moor­fields in 1676, and then to St George's Fields in Southwark which was op­en­ed in 1815 on the site of a notorious tavern. The last location was Monks Orchard in West Wickham in 1930.

Outside inspection had to concern itself with abuses in the manage­ment of Bedlam, and in every century there were several commissions of investigation. As early as 1656, John Evelyn noted in his Diary that he saw poor creatures in Bedlam in chains, in cages.

Visitors in a ward in Bedlam, Date ?
Photo credit: Huffpost

At Moorfields, the buildings were so spectacular from the outside that they were compared to Versailles. But Bedlam’s grand palatial exterior belied the barbaric treatments fac­ed by the insane within. People with dement­ia, schiz­ophrenia, epilepsy, depression and ret­arded learning were subjected to horrendous cruelty and ex­periment­ation by the facility managers aka keepers. With an under­standing of mental health that was very poor, treatments bor­dered on torture.

Not surprisingly Bedlam was racked by scandals. Inmates slept naked on straw in the cold, tormented by sadistic keepers. Manacles, chains, locks and cold baths were part of the treatment in the fac­ility. Patients were often chained up to walls and were some­times starved to death.

Now here is the surprising part of the story. Until 1770, this Pal­ace of Lunatics opened its doors to paying spectators. Visitors could walk freely through the corridors, observing and provoking the patients as if they were animals at a zoo. It became the custom for the idle classes (eg nobility and their friends) to visit Bed­lam and observe the antics of the insane patients as a novel form of amusement. Advert­ising consolidated the place of Bethlem Royal Hospital as one of Georgian London’s tourist hotspot, like the Tower of London. The tourist information openly acknowledged that patients were “often treated like animals”, housed in institutions that were “little more than human zoos”.

Why would tourism at Bedlam have been tolerated and even encourag­ed? And why was provocation allowed? Firstly it was hoped that seeing the “caged, insane animals in cages” would serve as a warning to the sane against vice and behavioural instab­ility. If that worked!

Secondly these visits brought in extra income for Bedlam. One penny was charged for ad­mission into the hosp­ital in order that an annual income of 400 pounds could be real­is­ed. This would mean that nearly 100,000 people visited the hospital in the course of a year.

Thirdly in Prisons, Asylums and the Public (2011), Janet Miron argued that for asylum administrators, encouraging tourism became a way to gain the public's confidence. It discouraged scep­ticism reg­ard­ing treatment and helped address the social stigma surrounding in­sanity. To protect staff work in normal condit­ions, not in the glare of tourism, the limited open hours were printed in the local newspaper. 

Fourthly was a factor that I did not understand: translating the nasty Bedlam realities into entertainment and pleasure. Wild lunatic inmates, far from resembling hum­an beings, proved reassuring. They collapsed the terr­ify­ing reality of "descent into madness" to a sub-human freak. "Just looking" thus became voyeuristic, the spectator cast into the role of the voyeur who relished the spectacle. By dev­el­oping an under­standing of the dark sites in society, they often proved reassuring for the sane, healthy and alive visitor. They rein­forced the visitor’s own sense of wellbeing, both mental and physical. Visiting the asylum would proved to be a form of esc­ap­ism, intended to entertain and titillate.

This form of voyeuristic spectatorship was best expressed in plate 8 of Hogarth’s A Rake's Progress, Bedlam’s best-known representation. Hogarth depicted two fashionable ladies visiting the hospital as a show place, while his Rake, at the end of the Progress, was being fettered by a keeper.
Bedlam in Moor­fields 
from 1676.

Bedlam in St George's Fields in Southwark
in the 19th century.

After an Investigation in 1851, the hospital came under regular government inspection and improved its care of the insane. Follow­ing the rise of C19th medical treatment, insanity came in­creasingly to be recognised as a curable disease. It was argued that insanity was caused by the draining of the patient's mental energy. So to recover, the mentally ill needed rest, meaningful empl­oy­ment, appropriate socialisation, good hygiene and kindness.

New asylums for treating insanity were purpose-built. Every element of the buildings, both inside and out, was considered an integral part of treatment. The times when Bedlam-inmates were subjects of horrendous cruelty and experimentation were over.

This new philosophy, treat and cure rather than incarcerate, spread quickly. Throughout the 1800s, institutions opened in large numbers across the Western world. In the later C19th, travellers visited asylums to admire the architecture and grounds, not the cages. Tourists admired the material side effects of the shift toward treatment: beautiful gardens, manicured lawns, inter­esting architecture and elegant proportions that presented a welcoming, healthful face. Some mental health centres adopted the moral treatment philosophy of meaningful work, including gardening.


Jo-Anne's Ramblings said...

How those with mental health issues way back when were treated appallingly when I see or read about those days I get angry and sad and thankful I did not live during such times

roentare said...

one of the nursing homes I visit is called Bethlehem. It has dodgy treatment towards the residents too. I found similarity between the two comparing our notes!

Andrew said...

I would like to think that the opening of asylums for tourism also brought sympathy and a desire to help. Perhaps I am naive.

Deb said...

I realise that Bedlam was not supervised by the government or church, and was a popular London attraction for the ghoulishly amused upper classes. Good grief. What did the wealthy visitors do it they faced insanity in their own families?

jabblog said...

Fascinating history.
Voyeurism has always been a part of human nature, I believe. There is a natural interest in that which is unfamiliar or to be feared. Why else would people attend public executions? 'Freaks' were also part of travelling circuses, not so very far removed from attendance at Bedlam and the like. They were not treated kindly, either.

Britta said...

Dear Helen - wow, that is hard stuff! It might have had a function of deterrence - even nowadays one should consider twice if one attempts (without "success") suicide, because those ones have to stay in psychiatric clinics for a while (though of course these are not comparable with those in Bedlem).
Your post made me think of Collin's "Woman in White" - in those times often people who became old or recalcitrant were put into asylums so that the heirs could get at their money.
As to the cruelty of the "tourists" - that makes me think of the gladiator fights, but even worse. Or the spectators when someone had to go to the guillotine. Nowadays - people don't change that much - a more "humane" sequel might be the "reality shows" in TV, where really repulsive people are shown. But that does "only" do spiritual damage, I think.

Student, for Helen said...

Thank you for your comments. Helen will be back tomorrow evening to respond.

Margaret D said...

Good heavens! Thanks for enlightening me/us on this topic.
Way back then the patients were treated so badly, thankfully it much improved over the years.
How dreadful to charge a 'Fee' to see these tormented people, such a disgrace in todays thinking.

Diane Bohlen said...

After reading your post, I thought you might be interested in the architecture and story of this mental hospital where my mother trained and worked in her twenties: Claybury Hospital London.



Hels said...


even though it was clear that insanity was at best "controlled" inside sealed institutions, protecting normal families outside, the authorities knew enough to run several commissions of investigation about the treatment of patients inside. The chains, cages, torture, starvation, nakedness were unhelpful, illegal and tortuous. Even so, insanity did not come to be recognised as a potentially curable disease until the mid 19th century, rather than as being caused by evil spirits.

Hels said...


where was the Bethlehem nursing home you visited and how long ago? I have no doubt bad treatment is still dished out to elderly or sick people incapable of protecting themselves. But at least nursing homes these days have to be accountable to state and health authorities.

Hels said...


I am not sure that the asylums were opened up to bring sympathy and a desire to help amongst healthy, wealthy "tourists". All the paintings and cartoons that I have seen suggested that the tourists were laughing themselves silly, or poking the poor victims in their orifices.

Hels said...


Respectable families said they never had insanity in their families. But now everyone realises that they got rid of the insane members of their families to remote facilities that were never visited by the family again.

Think of Rosemary Kennedy's erratic behaviour that made her father fear she would damage his political career. Joe Kennedy Sn requested that surgeons perform a lobotomy on Rosemary in 1941, leaving Rosemary with the mental capacity of a toddler. Joe Kennedy Sn had her locked away and never visited her again.

Hels said...


When poor citizens suffered, they had to rely on local parishes which sometimes provided charity-funded asylums, and some ended up in workhouses or prisons. I assume that wealthy tourists were allowed into all those facilities so that 1] they would feel very grateful for their own respectable lives and 2] to totally separate themselves from the dirty, alcoholic working classes.

Letting the Great Unwashed see public executions was more of a warning of what would happen to them, if they did crimes like the executed criminals. Not an entertainment at all :(

Hels said...


thank you for mentioning the Collins book, "Woman in White". I had totally forgotten the notion that old or insane people were put into asylums so that the heirs could get at their money.

The cruelty of tourists who toured the asylums and other horrid institutions has never really ended, as you say. I have seen viewers roar with pleasure when one boxer beats his opponent in the head, until he collapses into a foamy mess. Or horse racing where the jockey whips the horse into submission.

Hels said...


you have been very patient, thank you :)

Hels said...


it was possible that the entry fee was considered a donation to a religious organisation, thanking them for their love of the poor. Or more likely, it was the cost of entertainment, like they would have paid to go to the theatre.

It took a long time to see dement­ia, schiz­ophrenia, epilepsy and depression as "normal" diseases, and that cruelty to the patients was totally unhelpful. Even as medical knowledge continues to improve this century, we can be very grateful that most people will never have to live through those horrors again.

Hels said...


many many thanks. In 1889 the uncompleted building passed to the newly created London County Council which opened it as the Claybury Lunatic Asylum. With 2,500 patients! Those few decades made all the difference, didn't they? Claybury had become a major centre of psychiatric learning, for its research, in introducing new forms of treatment and the high standard of care provided for the mentally ill. And later the introduction of new drugs.

Joe said...

Helen, Australians might think we didn't struggle with the same mental health issues. So I recommend The Evolution and Devolution of Mental Health Services in Australia by Lila Vrklevski, Kathy Eljiz and David Greenfield. 2017, Vol 9, #10


Hels said...


the introduction is crystal clear, many thanks.
Many of the 750 convicts on the First Fleet in 1788 were mentally ill. The new settlement was governed as a military autocracy, whereby the Governor’s authority was absolute and it was the legal foundation on which lunacy administration rested. The penal nature of the colony, steeped in a military and custodial regime influenced the model of care. There was no distinction made between criminals with intellectual disability or mental illness. Anyone who was deemed a risk to society was imprisoned.

Initially those designated criminals, idiots or lunatics were bundled together in the Town Gaol at Parramatta. They were a menace to the community at large. By 1811 a mental asylum opened at Castle Hill NSW in an attempt to separate those who were criminal from those who were mentally ill. Untrained male attendants hired for their physical size staffed it.

Luiz Gomes said...

Bom dia de domingo e um excelente mês de outubro, com muita paz e saúde minha querida amiga.

Hels said...


Spot on! 4 Corners investigated how children with intellectual disabilities were being constantly restrained as part of a radical medical programme, funded and supervised by the National Disability Insurance Scheme. They concluded that the violence, abuse, neglect and exploitation of children with disability has not stopped.

I understand that children with disabilities can exhaust the patience of both parents and carers, and I understand that carers may not have the knowledge and training that they need. But abuses have been reported to the authorities for over 100 years!!!

Let me tell you two experiences I witnessed. In the 1990s, I used to regularly visit my elderly grandmother in a local carehome. a] Once I warmly encouraged my gran to play the piano in the visitors' lounge room - her memory was fine but her fingers were awful. The Director of Care came storming out of her office and slammed the piano lid on gran's hands. b] Once I was watching some of the elderly women residents having a fantastic time, standing on chairs and hanging up the curtain decorations on an inside succah. The same Director stormed out in, pulled the elderly women down from their chairs and locked them in their rooms. That Director was eventually sacked, but terrible damage had been done to elderlies who could not protect themselves.

Hels said...


safely caring for needy adults and children has been a vital issue for a long time, and has been analysed in many communities around the world. Until the state and federal authorities take the reports from residents, their families and the caring staff seriously. Daily if necessary.

mem said...

That is truly appalling . That Director should have been charged not just sacked!!! I guess she was protected from higher up by those worried about reputational damage . We have seen way too much of that is many organizations particularly religious who hold themselves up as the arbiters of morals and values . Seems a dangerous occupation to be, so many have been help up to ridicule and disappointment .

River said...

I could say I'm glad that today's methods are much more humane, but how humane is it when governments close these facilities and many who lived there and were cared for are now left to themselves and often become homeless on the streets, some of these people aren't even capable of remembering to take their medications.

Hels said...


even the sacking did not come easily :( There were a number of meetings between the residents' families and the nursing home Board, but I doubt that families' views were taken as seriously as the Director's views. After all, the elderly still living in the late 20th century had been great disturbed in surviving WW2 and could be largely ignored :(

Reminds me of carers ignoring those locked into asylums in the olden days. Because of their age, tb, alcoholism or dementia, the residents could be totally ignored :(

Hels said...


many residential institutions were closed from the 1960s on, to free up the residents to live at home with the support of in-home professionals. Small children were taken out of large impersonal orphanages and put into foster care with individual, loving families.

In both cases, home support WAS indeed far cheaper for the government or church than giant, fully staffed institutions. But the official argument was always about residents' personal needs being met *cough*, not about saving tax payers' money *cough cough*.

Parnassus said...

Hello Hels, Before I left Cleveland, I spent quite some time visiting at the St. Augustine care facility, which was for the elderly and also for those requiring long-term rehabilitation. I witnessed the staff there always very helpful, cheerful, and considerate to the residents. In general it was a sad place to visit, especially the younger people with brain injuries who were unlikely to recover a normal life, and whose friends or family stopped visiting after a while. But still this was worlds away from the nightmare institutions that you describe here.
Charlotte Perkins Gilman's very excellent short story The Yellow Wallpaper is about the conundrums of treating mental illness with rest (versus activity), even when apparently good (and possibly private) care was provided. It is only about ten pages, and once you read it you will never forget it. Here is the Gutenberg link:


Hels said...


I can imagine that St Augustine Care Facility was indeed both a caring and a sad place to live in. I cannot imagine the misery of people who will rarely hold down jobs, marry, have children, write blog posts, read daily newspapers or travel widely. But if the residents are not placed in real homes or visited regularly by family and friends, the care facility becomes like a gaol instead of a home.

The Yellow Wallpaper was very important when it was written way back in the 1890s. Can you imagine the impact of isolating and locking up depressed women behind windows with bars? Of course the doctors thought they were doing the right thing.